Posts Tagged ‘CMS comprehensive primary care’

CCMI’s Primary Care Initiatives Produce Modest, Mixed Results

February 8th, 2018 by Melanie Matthews

Comprehensive Primary Care Initiative Analysis

Comprehensive Primary Care Initiative Analysis: Mixed, Modest Results

The Center for Medicare & Medicaid Innovation’s (CCMI) Primary Care Initiatives have produced modest and mixed results, according to a final review of the program conducted by Kennell and Associates, Inc. and RTI International and released by CMS.

The six CMMI initiatives included in the review are the Comprehensive Primary Care (CPC) initiative, the Federally Qualified Health Center (FQHC) Advanced Primacy Care Practice demonstration, the Independence at Home (IAH) demonstration, the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration, the State Innovation Models (SIM) initiative, and the Health Care Innovation Awards Primary Care Redesign Programs (HCIA-PCR), which CMS identified as the most focused on primary care redesign.

Initiative practices did make large strides toward becoming Patient-Centered Medical Homes (PCMHs) or advanced primary care practices. While less than 10 percent of initiative FQHCs had any PCMH recognition status prior to the initiative, 70 percent achieved NCQA Level-3 recognition by the end of the initiative. Similarly, the CPC evaluation found that CPC initiative practices improved their PCMH Assessment scores by about 50 percent.

While the review did not find consistent impacts across the initiatives or by setting within initiatives for any of the four core outcomes identified by CMS: fee-for-service Medicare hospital admissions, 30-day readmissions, outpatient ED visits, and Medicare expenditures, some of the initiatives did report some positive outcomes.

Of the 22 more granular initiative settings (seven CPC regions, FQHC as a whole, six HCIA-PCR awardees, and eight MAPCP states) for which cumulative results through Year 3 were available, 10 settings experienced improvement relative to their comparison group for at least one of the four core outcome measures at a significance level and three of these settings (two CPC regions and HCIA TransforMED) experienced improvement on at least two core outcomes.

Across four initiatives (CPC, MAPCP, HCIA-PCR, and FQHC), analyses indicated that the aggregate impacts on the core outcomes were small and not statistically significant.

Certain population subgroups and practice types across initiatives experienced more favorable outcomes, according to the analysis. Specifically, beneficiaries originally eligible for Medicare due to disability and beneficiaries with poor health (highest quartile of baseline HCC risk scores) experienced slower growth in Medicare expenditures. However, disability status and HCC risk score were not associated with statically significant impacts on overall rates of hospitalizations or ED visits, and non-dually eligible beneficiaries and those who were not originally eligible for Medicare due to disability experienced lower rates of 30-day readmissions.

The analysis also found slower growth in Medicare expenditures and lower rates of inpatient admissions and ED visits among practices with fewer than six practitioners and also among practices that were not multispecialty practices.

Other key findings from the analysis:

  • There are advantages to both state-convened and CMS-convened initiatives;
  • Practice-level factors are important in addressing transformation challenges; and
  • Initiative-level supports also helped practices meet transformation challenges.

WellPoint ‘Leaves No Primary Care Practice Behind’ on Road to Value-Based Payment Reform

November 4th, 2013 by Patricia Donovan

To foster its ambitious goal of moving 75 percent of its physician practices from visit- to value-based reimbursement over the next three years, WellPoint has placed a variety of resources at the practices’ disposal.

Building on its successes with the patient-centered medical home, a model it has deployed since 2008, WellPoint is transitioning its practices from a fee-for-service world to one that rewards doctors when they improve both the quality and affordability of the care they provide. The payment reform starts with a care coordination fee for activities that are not “visit”-based. Once physicians meet an established quality gate, they are eligible to share in any savings achieved.

Supports for providers in WellPoint’s 14 markets as they transition to the new payment system are designed to meet the needs of all its practices, explains Julie Schilz, director of care delivery transformation for WellPoint — from small individual practices to large integrated health systems.

“We have a ‘Leave No Primary Care Practice Behind’ philosophy,” said Ms. Schilz. “Some practices have wonderful systems or enhanced capabilities, like a Patient-Centered Medical Home recognition. How we bring ourselves to these practices certainly looks different than [our presentation to] a practice just starting on its transformation journey.”

Resources range from toolkits, Web-based care delivery software and a learning collaborative that offers live and recorded training sessions and virtual “call-in” hours to access to three consultants with distinct areas of expertise.

During a recent webinar on Aligning Value-Based Payment with Physician Practice Transformation, Ms. Schilz described how the three consultants assist the practices virtually, via site visits or by curating content for the learning collaborative:

  • The Provider Clinical Liaison helps practices develop essential care coordination and care management skills, such as developing a care plan, and also acts as the interface between the primary care provider and WellPoint.
  • The Community Collaboration Manager helps providers make sense of reports and data and get on track for transformation, while contributing to learning collaborative content.
  • The Patient-Centered Care Consultant works with practices to boost quality improvement efforts and connect providers to community tools and resources.

To maximize a practice’s financial rewards, providers must routinely mine patient data to identify opportunities to improve care. WellPoint’s nine separate reports available to care teams tabulate everything from no-longer-active patients to a practice’s “hot spotters” — patients at risk of readmission or whose chronic illness history turns up glaring care gaps.

While primary care practices acclimate to the new payment model, WellPoint is simultaneously participating in Comprehensive Primary Care initiatives in four states, a program whose value-based focus meshes well with WellPoint’s ongoing payment transformation.

Calling patient-centered care “the new normal,” Ms. Schilz said WellPoint is also laying the foundation for construction of medical home neighborhoods. Expected to launch in 2014: WellPoint’s first iteration of patient-centered specialty care (PCSC). This limited venture, which encompasses four key areas, will expand care coordination to a few willing specialties: cardiology, endocrinology and OB-GYN.

“We will start the dialogue between specialists and primary care to talk about how we assure that our patients are flowing back and forth from our offices in an effective way.”

Click here to listen to an interview with Julie Schilz.